被诉人:法定代表人:地址: 请求事项:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
事实和理由:(包括证据和证据来源,证人姓名和住址等情况): _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 此致 劳动争议仲裁委员会
申诉人(单位):___________(签名或盖章)
__________年_______月_________日